{"id":743,"date":"2023-02-13T21:57:44","date_gmt":"2023-02-13T21:57:44","guid":{"rendered":"https:\/\/doctorantoniogonzalez.com\/?page_id=743"},"modified":"2023-02-21T20:28:33","modified_gmt":"2023-02-21T20:28:33","slug":"cirugia-general-y-digestiva-de-urgencias","status":"publish","type":"page","link":"https:\/\/doctorantoniogonzalez.com\/en\/servicios\/cirugia-general-y-digestiva-de-urgencias\/","title":{"rendered":"Emergency general and digestive surgery"},"content":{"rendered":"
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General and emergency\nand gastrointestinal surgery<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Emergency general and digestive surgery is one of the pillars of the speciality.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tIn a large hospital, 20 to 40 % of total admissions are due to urgent pathologies, although not all of them end up in surgery. \t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\tEmergency general and digestive surgery is one of the pillars of the speciality. In a large hospital, 20 to 40 % of total admissions are due to emergency pathologies, although not all of them end up in surgery. Moreover, they are the main cause of overall mortality in them as it is a pathology that has the potential to cause failure of normal physiology in already debilitated patients on many occasions.

It is well known that the results improve when patients are treated by surgeons with a special dedication to it.\n\tThere are many pathologies that need to be treated urgently.

Correct diagnosis, adequate resuscitation, appropriate treatment and exquisite postoperative follow-up are the basis for success.\n\tWe will briefly describe 4 of the most frequent urgent surgical pathologies in our speciality.\n\n\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAcute appendicitis\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\tThe caecal appendix is a portion of the intestine that originates at the beginning of the large intestine, in the cecum. It is a cecal pouch and faeces can accumulate in it and obstruct its lumen. This is the basis for the development of acute appendicitis. In children, the origin of the obstruction of the lumen of the appendix can be parasites and even appendiceal tumours can trigger it.

\n\tIt is the most frequent surgical emergency in the field of general and digestive system surgery and its diagnosis and treatment has changed substantially in recent years.

\n\tThe characteristic clinical picture is abdominal pain starting in the epigastric or central abdomen and progressively moving to the lower right quadrant, associated with loss of appetite, nausea and vomiting. General laboratory tests can support the diagnosis but nowadays the clinical and laboratory tests will almost always determine which patients will have an abdominal echo or abdominal CT scan. The aim is not to operate on patients who do not need it.

\n\tWhen simple acute appendicitis is confirmed, appendectomy is still considered the standard treatment at present. The laparoscopic approach is the approach of choice. However, in simple appendicitis and well selected cases, non-operative treatment is considered safe, but with high recurrence rates and increased costs.

\n\tIn case of complicated appendicitis, there are two scenarios:
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- Acute appendicitis with progression to focal or diffuse peritonitis: in these cases surgery will always be the necessary treatment.

\n- Acute appendicitis with development of a pericecal inflammatory process, the so-called appendiceal mass, appendiceal plastron or advanced appendicitis: in these cases non-operative treatment with antibiotics and percutaneous abscess drainage if necessary is usually preferred. It is currently debated whether it is necessary to remove the appendix a few months after the acute episode. If laparoscopic surgery is possible in this context, which is rather difficult, surgical treatment may be accepted. \t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAcute cholecystitis\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\tAcute cholecystitis is inflammation and subsequent infection of the gallbladder, usually due to the presence of gallstones.\n\tPatients with acute cholecystitis usually have pain under the right ribcage, fever, nausea and vomiting. If jaundice (yellowing of the skin and mucous membranes) is present, infection of the entire biliary tract must be ruled out.
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Diagnosis is based on laboratory tests and ultrasound, which will assess the presence of stones in the gallbladder and determine whether the walls of the gallbladder are thickened, as well as the size of the bile duct.\n\tIf there is suspicion that the bile duct is blocked, this situation should be assessed before surgery by means of an MRI or endoscopic ultrasonography, or in the operating theatre by a contrast-enhanced examination of the bile duct. If it is confirmed that the bile duct is occupied, endoscopic removal is the most widespread treatment, although laparoscopic removal during surgery is increasingly advocated.

\n\tThe best treatment for acute cholecystitis is laparoscopic cholecystectomy, but it may not be necessary if general conditions are very poor. Antibiotics and percutaneous drainage of the gallbladder are sometimes substituted. \n\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAcute diverticulitis of the colon\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\tAcute diverticulitis of the colon is the involvement of a segment of the large intestine caused by inflammation of the diverticula. It is a very common pathology and, fortunately, most of the time it responds adequately to non-operative treatment.

\n\tAlthough it can affect any part of the abdomen, the left colon and sigmoid colon are most commonly affected. For this reason, patients most commonly present with pain in the lower left quadrant of the abdomen and fever.

\n\tDiagnosis is based on clinical findings. Blood tests will generally show an increase in white blood cells and substances related to inflammation, but the abdominal CT scan will confirm the diagnosis and allow staging.

\n\tEarly stages can be treated at home, even without antibiotics, but when inflammation is more severe, antibiotics are always necessary. If large abscesses form and can be drained, this should be done with the help of radiologists. If they are small or cannot be drained, only antibiotic treatment is possible. In case of failure of non-operative treatment or when the patient presents with peritonitis, surgical intervention will be necessary, which can be done by laparoscopic approach if the patient's general circumstances allow it. The current trend is to avoid stoma formation as stomas are often not reversed. Even when the patient is very deteriorated, it is possible to perform surgery in steps: initial damage control and subsequent revisions of the abdomen until the bowel is reattached. \n
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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tComplicated inguinocrural hernias\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\tInguinocrural hernias are very common and sometimes require emergency surgery when they become complicated, as they can lead to necrosis of a portion of the intestine and its perforation. \n\t

Patients with a complicated inguinocrural hernia usually have a painful groin lump and associated vomiting and bowel closure.

\n\tDiagnosis is based on clinical and physical examination, although imaging tests such as ultrasound or abdominal CT scan are often performed to confirm the diagnosis.

\n\tUrgent surgery will be required to repair the hernia and assess the condition of the intestine trapped in the hernia. If it is necrotic, it will need to be resected. Although the most commonly used approach to treat a complicated hernia is the open approach, minimally invasive surgery may be considered if the surgeon has the technical skills to perform it. \n\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tEmergency general and digestive surgery\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAbdominal wall surgery\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tObesity or bariatric surgery\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tEndocrine surgery\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tOesophageal and gastrointestinal surgery\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tGallbladder surgery\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tColon cancer surgery\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tProctology\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tPelvic floor surgery\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tEmergency general and digestive surgery\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"

Cirug\u00eda general y digestiva de urgencias La cirugia general y digestiva de urgencias es uno de los pilares de la especialidad En un gran hospital, del 20 al 40 % de los ingresos totales se deben a patolog\u00edas urgentes, aunque no todas acaban en cirug\u00eda. La cirugia general y digestiva de urgencias es uno de […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":687,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-743","page","type-page","status-publish","hentry"],"yoast_head":"\nCirug\u00eda general y digestiva de urgencias - Doctor Gonz\u00e1lez<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/doctorantoniogonzalez.com\/en\/servicios\/cirugia-general-y-digestiva-de-urgencias\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cirug\u00eda general y digestiva de urgencias - Doctor Gonz\u00e1lez\" \/>\n<meta property=\"og:description\" content=\"Cirug\u00eda general y digestiva de urgencias La cirugia general y digestiva de urgencias es uno de los pilares de la especialidad En un gran hospital, del 20 al 40 % de los ingresos totales se deben a patolog\u00edas urgentes, aunque no todas acaban en cirug\u00eda. 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